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Diabetes care provider helps others adopt new technology
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HOUSTON — Diabetes care is not a static endeavor. Health care providers and patients alike are inundated with new technology and information about how to best care for diabetes. For Jennifer A. LeBlanc, BSN, RN, CDE, director of professional education and care delivery at the Joslin Diabetes Center of Harvard Medical School in Boston, finding ways to simplify this process is crucial.
To that end, LeBlanc and colleagues developed a program called ActNow, which is specifically designed to help improve knowledge and use of continuous glucose monitoring both for providers and the people they treat. Her work on this program earned LeBlanc the American Association of Diabetes Educators’ Innovative Use of Technology Award.
LeBlanc spoke with Endocrine Today about the genesis of ActNow, the importance of improving CGM adoption and her continued research on addressing the use of new technologies in diabetes treatment.
What was the defining moment that led you to your field?
LeBlanc: I was diagnosed with type 1 diabetes as a young child in the early 90s and was not enthusiastic about the care and educational support I received. I recognized that small things would have made a big difference in the way I coped with having an exhausting chronic illness. I also volunteered at a summer camp for kids both as a counselor and as a new nurse and was amazed by the drastic differences in individual campers’ outlooks on life and their ability to safely manage their disease.
I always felt that among the social, cultural and societal determinants that affect a patient’s physical and mental health, the education and care provided by a health care team, plays a major role. There are strong discrepancies in this area depending on who a patient sees for their care. I knew then that I would dedicate my career to advancing the field of diabetes for not only patients, but for health care providers, in hopes of narrowing the gap in the quality of care and education available to patients.
How did ActNow come about and how has it been implemented?
LeBlanc: I attended the Harvard Macy’s Institute program designed for educators and administrators in health care. The program started in 1994 and is a consortium between Harvard’s medical school, graduate school and Kennedy School of business. The program is aimed at bringing together scholars and thought leaders to think differently about the way we educate and how we deliver care.
I spent much of my time there reflecting on my 10 years working for a leading medical device company that designed insulin pumps and continuous glucose monitors. I remember all the time and energy that went into training health care providers on these devices as well as the patients to ensure they were successful. It occurred to me often that you can have the best piece of technology in the world, but if you cannot educate in a way that the patient understands, connects with and trusts and that inevitably leads to behavior change, then we are going to continue to spin in circles, wasting time and health care dollars and not having true impact on patients’ health.
I then spent some time evaluating and reviewing the way patients are trained and followed up with when they start on diabetes technology in the clinic setting where I work and at our affiliated centers. I realized our education has been designed to be very “checklist” oriented. It is designed like this to ensure we have proper documentation for safety as well as to ensure we are covering areas that are deemed important for patients to learn.
Unfortunately, this checklist system can limit the ability to provide customized care. Also, with these checklists, we had a fairly narrow view for how we measured a patient’s glycemic health. We mostly focused on HbA1c. Now, thanks to technology like CGM, we can look at a much broader picture of diabetes with new glucometrics like time in range. I also found that most behavioral health research indicates that assessing quality of life at each visit and practicing shared decision-making is essential in diabetes care.
Lastly, we know from the science of learning that the way patients absorb and retain information warrants active engagement and intentional activities by their health care provider. With our hectic clinic schedules and juggling competing priorities, creating this experiential learning environment is not always accomplished. In observing many patient trainings, it was evident that teaching does not always result in learning.
Based on all these findings, I created the ActNow framework to be used as an educational tool to guide providers and patients through a session using CGM. The main goals are to increase patient satisfaction, autonomy and success rates with their devices as well as to help them accomplish their diabetes health and life goals.
The framework has been tested and revised thanks to the team at the Harvard Macys Institute. So far it has been taught to more than 200 health care providers (not including the presentation at the ADA Scientific sessions this past June) and is undergoing evaluation at the Joslin Diabetes Center in Boston. We are doing a post-implementation health care provider and patient feedback analysis and are moving into clinical outcome indicators. The initial results have been extremely positive, and we are looking forward to publishing this early next year.
Why is this an important program, particularly in helping with the adoption of CGM?
LeBlanc: We know that rates of CGM adoption are unimpressive considering the incredible impact it has on improving time in range, HbA1c and prevention of severe hypoglycemia. We also know that attrition rates are still fairly high, meaning people are not always continuously wearing their devices. Much of this stems from barriers related to self-esteem, interruption in their daily lives, and not seeing the return on investment. Also, we are embarking on a time when many companies are promoting online learning. While this is convenient for patients and device companies, there is no proven way of ensuring the information is being translated effectively and training is specific to the patient. As providers, we can use this ActNow framework and patient tool as a follow-up to these online trainings.
My hope is that if more people are able to see the value in the care they receive, gain more knowledge about how to use their devices, and feel confident and hopeful about meeting their goals, they will use CGM. I want patients to see that their care is evolving, not just in how they integrate new technologies, but also in the way they partner with their care providers.
Are there other diabetes technologies that the ActNow framework can address? If so, what are some other areas of focus or ones you hope to address?
LeBlanc: The principals behind this framework can honestly be applied to many patient appointments regardless of their therapy. It’s a natural fit for CGM, automated insulin delivery and insulin pumps, but as long as a patient is using insulin and is capturing glucose data on a meter or digital app that can give us information like time in range, it would flow in exactly the same way. We are working on tweaking the tool slightly for patients who are on non-insulin agents and for those that have prediabetes. Also, we are excited and doing preliminary research to help design a similar “family style” framework for group appointments in pediatrics.
What area of research most interests you right now and why?
LeBlanc: My passion currently is evaluating the way health care providers are educated on new innovations in diabetes. As many know, the world of diabetes technology is rapidly evolving with scores of new devices on the market, being piloted and approved. These require substantial training and understanding. Lack of continuous education for health care providers can be a cause of clinical inertia in our field.
Also, there are many barriers to ensuring this knowledge transaction is done effectively and without bias. Even in 2019, despite the uptake in new technology, fewer than half of patients with diabetes are meeting target goals. My colleague Nuha El Sayed, MD, MMs, and I are currently conducting an IRB-approved study aimed at detecting barriers and exploring the experiences, preferences and attitudes of the various diabetes providers. Our hope is that this will shed the light on providers’ sources of information and learning about new technology. If anyone is interested in taking the survey and contributing to this research, the link is here: www.surveymonkey.com/r/NVGQSQH.
What do you think will have the greatest influence on your field in the next 10 years?
LeBlanc: Among the top influences, in my opinion, will be advancements in new technology and therapy, specifically automated insulin-delivery devices, as well as the newer classes of medications. I think we will learn more about the microbiome, which will affect the way we eat and think about nutrition. Of course, my hope is that through continued advocacy at the government level, there will be more focus on ensuring everyone has access to the same quality care.
As far as education goes, I believe we will move toward telehealth and online education delivery models as well as new guidelines for effective ways to deliver post-graduate and professional education. I hope I can help in some way move this ball forward!
Disclosure: LeBlanc reports no relevant financial disclosures.